Provider Demographics
NPI:1659602977
Name:BENTLEY-FELL, ANNE (OT)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:BENTLEY-FELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-2132
Mailing Address - Country:US
Mailing Address - Phone:973-885-1010
Mailing Address - Fax:
Practice Address - Street 1:455 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-2132
Practice Address - Country:US
Practice Address - Phone:973-885-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00171300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223845606OtherTAX ID #